Forms

Consumers

Document Title
Customer Service Evaluation Form
Speaker Request Form

Applicants

General Applications
Document Title
Licensure by Examination Instructions and Supplemental Forms
Licensure by Examination (8-Year Retake) Fee Schedule and Instructions
Licensure by Endorsement Instructions and Supplemental Forms
Notification of Social Security Number Change
Request for Accommodation of Disabilities
Request for Transcript
Advanced Practice Applications
Document Title
Public Health Nurse Certificate Application Instructions and Supplemental Forms
Clinical Nurse Specialist (CNS) Certification Application Instructions and Supplemental Forms
Nurse Anesthetist (NA) Certification Application Instructions and Supplemental Forms
Nurse-Midwife (NM) Certification Application Instructions and Supplemental Forms
Nurse Practitioner (NP) Certification Application Instructions and Supplemental Forms
Psychiatric/Mental Health (P/MH) Nurse Application Instructions and Supplemental Forms
Nurse Midwife Furnishing Number Application Instructions and Supplemental Forms
Nurse Practitioner Furnishing Number Application Instructions and Supplemental Forms

Education

Document Title
Continuing Approval - Nursing Program
Instructions for Institutions Seeking Approval of New Prelicensure Registered Nursing Program
New School of Nursing - Feasibility Study Report
Request for Major Curriculum Revision

Licensees

Document Title
Active to Inactive License
Application for Reinstatement of a Lapsed License - 8-Year Renewal
Continuing Education Provider Initial Renewal Notice
Notification of Social Security Number Change
Renewal Fingerprint Question Certification
Request for Duplicate Certificate

Enforcement

Document Title
Complaint
Expert Practice Consultant Application
Report of Settlement, Judgment, or Arbitration Award

Probation

Document Title
BRNPROB100 - AA-NSG Calendar BRNPROB112 - Mental Examination Form
BRNPROB101 - RN WPE BRNPROB113 - Employment Approval Form
BRNPROB102 - NP WPE BRNPROB114 - Fingerprint Instructions and Form
BRNPROB103 - CRNA WPE BRNPROB115 - First Source Enrollment Instructions
  BRNPROB116 - Rehabilitation - Treatment Form
BRNPROB105 - Tolled Update Form BRNPROB117 - Cost Recovery - Payment Plan
BRNPROB106 - Tolled - Request to Go into Tolled Status BRNPROB118 - Data Form
BRNPROB107 - Confidential Release Form BRNPROB119 - EDD Authorization for Release
BRNPROB108 - Physical Examination Form BRNPROB120 - Refresher Course and Clinical Approval Form
BRNPROB109 - Therapy Form BRNPROB110 - NSG Facilitator Form
BRNPROB122 - Relapse Prevention Plan BRNPROB111 - Psychotropic Mood Altering Form
BRNPROB123 - Rule Out Examination Addendum BRNDECAPP-01 - Process for Filing Petition
BRNDECAPP-05 - Petition for Early Termination of Probation BRNDECAPP-06 - Petition for Modification of Probation

Intervention

Document Title
Application for Nurse Support Group Facilitator/Co-Facilitator
Intervention Evaluation Committee (IEC) Application
Nurse Support Group Data Form